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    Baran Palanimuthu
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    Bleeding more than 500 ml from genital tract after delivery primary: within 24 hours secondary: after 24hours to 6 weeks postpartum epidemiology 2% of pregnancy Most common cause of maternal mortality worldwide. Primary (4t): tone (MAJOR 90%) myometrium has not contracted to cut off spiral arteries retained placental fragments Lacerations, episiomy, uterine rupture or inversion DIC, haemophilia, vWD

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    Bleeding more than 500 ml from genital tract after delivery primary: within 24 hours secondary: after 24hours to 6 weeks postpartum epidemiology 2% of pregnancy Most common cause of maternal mortality worldwide. Primary (4t): tone (MAJOR 90%) myometrium has not contracted to cut off spiral arteries retained placental fragments Lacerations, episiomy, uterine rupture or inversion DIC, haemophilia, vWD

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    23 views17 pages

    PPH

    Uploaded by

    Baran Palanimuthu
    Bleeding more than 500 ml from genital tract after delivery primary: within 24 hours secondary: after 24hours to 6 weeks postpartum epidemiology 2% of pregnancy Most common cause of maternal mortality worldwide. Primary (4t): tone (MAJOR 90%) myometrium has not contracted to cut off spiral arteries retained placental fragments Lacerations, episiomy, uterine rupture or inversion DIC, haemophilia, vWD

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    of 17

    Dr. Baran Palanimuthu , MD Department of Obstetrics & Gynaecology Sultan Abdul Halim General Hospital, Sg.

    Petani Kedah Darul Aman

    Definition
    Bleeding more than 500ml following delivery
    Primary: within 24 hours Secondary: after 24hours to 6 weeks postpartum

    Epidemiology
    2% of pregnancy
    Most common cause of maternal mortality worldwide

    Aetiology
    Primary (4 Ts): TONE (MAJOR 90%)

    myometrium has not contracted to cut off spiral arteries Retained placental fragments Lacerations, episiotomy, uterine rupture or inversion DIC, Haemophilia, vWD

    TISSUE

    TRAUMA

    THROMBIN

    Aetiology
    Secondary: Endometritis Retained placental tissue

    Risk Factor
    Overdistention Atony (Multiple pregnancies, polyhydramnios, LGA). Labor & Delivery: Antepartum haemorrhage, placenta praevia. C-section (Emergency>Elective). Prolonged labor >12hour Pre-eclampsia
    Previous PPH HELLP

    Clinical Presentation
    Bleeding continuous bleeding after delivery of placenta blood soaked pads and bedding Shock pallor collapse hypotension tachycardia

    Bimanual Compression

    B-Lynch Brace Suture

    Reduction of Uterine Inversion


    Johnsons Method

    Recognition

    Replacement

    Restitution

    Management Secondary PPH


    Exclude retention of placental tissue as a cause Ultrasound (identify retained placental tissue) Ultrasound guided removal of placental tissue under general anaesthesia
    Endometritis Antibiotic therapy

    Summary
    Bleeding more than 500 ml from genital tract after

    delivery Primary and secondary 4t tone, tissue, trauma, thrombin Multidiscipline management

    Thank you!

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